INCIDENCE, RISK-FACTORS, AND OUTCOME OF ANTITHYMOCYTE GLOBULIN TREATMENT OF STEROID-RESISTANT REJECTION AFTER LIVER-TRANSPLANTATION

We retrospectively analyzed the incidence and outcome of steroid-resis tant rejection (SRR) during the first 6 months after OLT in 126 patien ts receiving triple immunosuppression. A total of 95 patients either d id not experience acute rejection at all or had acute rejection that s ubsided without additional treatment. A total of 31 patients had biops y-proven acute rejection that required therapy: 18 patients had acute rejection that responded to steroid therapy (steroid-sensitive rejecti on, SSR); the remaining 13 patients had SRR and received ATG, At the o nset of acute rejection, no differences in clinical, biochemical, or i mmunological parameters were present between patients with SR and SRR. However, the histological grade of acute rejection in the initial bio psy was higher in patients with SRR (P = 0.05), ATG treatment was effe ctive in 10 of the 13 patients and was not associated with an increase d incidence of opportunistic infections. Patient and graft survival ra tes at 2 years were comparable In the three groups. These data show th at the incidence of SRR during the first 6 months after OLT is low and that its treatment with ATG is both effective and well tolerated.